DHA Case No. CWA 217154 (Wis. Div. Hearings and Appeals Jun. 17, 2025) (DHS) ↓ Download PDF IRIS participants may be disenrolled if they cannot or will not address health and safety concerns. In this case, the petitioner had seizures and “episodes of disorientation,” during which his caregiver would lock or barricade him in his […] Read more
Tag: 5.05.4 IRIS
CWA 217677 (06/09/2025)
Petitioner functionally eligible after considering use of adaptive equipment
DHA Case No. CWA 217677 (Wis. Div. Hearings and Appeals Jun. 9, 2025) (DHS) ↓ Download PDF To be functionally eligible for the IRIS program, an individual must require a “nursing home” level of care. In this case, the petitioner needed assistance with dressing and used adaptive equipment for bathing; he also needed assistance with […] Read more
DHA Case No. CWA 216919 (Wis. Div. Hearings and Appeals May 30, 2025) (DHS) ↓ Download PDF An IRIS participant’s budget is based in their long-term care functional screen. In this case, the petitioner’s Supportive Home Care (SHC) hours were reduced from 22.25 to 5 hour per week, even though his most recent functional screen […] Read more
DHA Case No. CWA 217205 (Wis. Div. Hearings and Appeals May 13, 2025) (DHS) ↓ Download PDF To be functionally eligible for home and community based long term care services, an individual must require a “nursing home” level of care. In this case, the petitioner’s condition improved after a bone marrow transplant; an updated functional […] Read more
DHA Case No. CWA 216858 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF A person is functionally eligible for IRIS if, among other criteria, the person cannot safely or appropriately perform one or more ADL and 3 or more IADLs and has cognitive impairment. In this case, the petitioner was a […] Read more
DHA Case No. CWA 216762 (Wis. Div. Hearings and Appeals Mar. 19, 2025) (DHS) ↓ Download PDF Around 2017 DHS instituted a policy that a caregiver should not be approved for more than 40 hours per week of paid services, including SHC covered by IRIS and other forms of caregiving such as personal care worker […] Read more
DHA Case No. CWA 216860 (Wis. Div. Hearings and Appeals Mar. 18, 2025) (DHS) ↓ Download PDF IRIS participants must pay their providers a “usual and customary rate.” In this case, the petitioner sought an increase in the daily rate of his adult day services provider from $157.50 to $168.50. Noting the difference between the customary […] Read more
DHA Case No. CWA 216647 (Wis. Div. Hearings and Appeals Feb. 17, 2025) (DHS) ↓ Download PDF An IRIS participant may be disenrolled if the agency is unable to ensure the participant’s health and safety. In this case, the petitioner lived with her daughter, who was also her caregiver and guardian. The petitioner eloped from […] Read more
DHA Case No. CWA 216141 (Wis. Div. Hearings and Appeals Feb. 13, 2025) (DHS) ↓ Download PDF IRIS participants may be involuntarily disenrolled for failure to spend the funds in their budget. In this case, the petitioner was repeatedly warned that her failure to spend her IRIS budget could result in disenrollment, and she ultimately […] Read more
DHA Case No. CWA 216117 (Wis. Div. Hearings and Appeals Feb. 11, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner’s renewal was due September 17 and partially submitted on September 18, but a required signature was not provided until October 10, resulting […] Read more
DHA Case No. CWA 216047 (Wis. Div. Hearings and Appeals Feb. 3, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner applied September 4 but did not complete verification until October 14, resulting in an enrollment date of November 1. Although the petitioner’s […] Read more
DHA Case No. CWA 215937 (Wis. Div. Hearings and Appeals Jan. 31, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner applied August 27, verified assets on October 3, and finished verification with proof of medical premiums November 5. Although the petitioner’s guardian […] Read more
DHA Case No. CWA 215724 (Wis. Div. Hearings and Appeals Jan. 10, 2025) (DHS) ↓ Download PDF A person is functionally eligible for Community Waivers long-term care programs if, among other criteria, the person cannot safely or appropriately perform 5 or more IADLs or 4 IADLs and has a cognitive impairment. In this case, the […] Read more
DHA Case No. CWA 218226 (Wis. Div. Hearings and Appeals Oct. 30, 2025) (DHS) ↓ Download PDF Home modifications may be an allowable service covered by IRIS if they are needed, safe, and cost-effective. In this case, the petitioner needed a way to access the first floor of her home but could not safely use […] Read more
DHA Case No. FCP 218386 (Wis. Div. Hearings and Appeals Sep. 23, 2025) (DHS) ↓ Download PDF When an agency error causes delay in an individual’s enrollment in an MCO, the Department may adjust the individual’s enrollment date. In this case, the petitioner switched from the IRIS program to the Family Care program with the […] Read more